# Successful Pedal Bypass in a Patient With Pseudoxanthoma Elasticum

## TL;DR

A patient with a rare metabolic disease successfully underwent a foot bypass surgery for severe leg artery disease.

## Contribution

This case report demonstrates successful distal bypass surgery for critical limb ischemia in a patient with pseudoxanthoma elasticum.

## Key findings

- Pedal bypass using the great saphenous vein successfully treated CLI in a PXE patient.
- The patient remained asymptomatic and showed healing of ulcers at follow-up visits.
- Multidisciplinary care and imaging are crucial for managing PAD in PXE patients.

## Abstract

Pseudoxanthoma elasticum (PXE) is a rare metabolic disease, causing calcification in the arterial media layer and further peripheral artery disease (PAD). A high rate of failure has been reported after endovascular and open surgical management of PAD among patients with PXE. Critical limb ischemia (CLI) rarely develops in PXE, and there are only few reports of its treatment.

We present a case report of a 57 year-old female diagnosed with pseudoxanthoma elasticum (PXE). She presented with critical limb ischemia (CLI) and was successfully treated with pedal bypass using the great saphenous vein.

Despite obtaining suboptimal outcomes through the initial approach of percutaneous transluminal angioplasty to treat critical limb ischemia, the subsequent bypass operation proved to be a success. At the first follow-up appointment at 1 month, the patient was asymptomatic and the ulceration had almost healed. The patient underwent an ultrasound examination at 3, 6, 12, and 24 months after discharge, and the surveillance was uncomplicated.

With a clear indication for surgery, limb-threatening ischemia can be successfully treated with distal bypass, if necessary, in patients with PXE similarly to atherosclerotic PADs. Appropriate diagnostic and surveillance imaging and the utilization of a multidisciplinary team are key components for effective management of PAD in patients with PXE.